ORIGINAL ARTICLE

Moderately premature infants at Kaiser Permanente Medical Care Program in California are discharged home earlier than their peers in Massachusetts and the United Kingdom

J Profit^1,2,3, J A F Zupancic¹, M C McCormick^1,4, D K Richardson¹, G J Escobar⁵, J Tucker⁶, W Tarnow-Mordi^6,7 and G Parry⁸

¹ Harvard Newborn Medicine Program, Children’s Hospital Boston and Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
² Baylor College of Medicine, Texas Children’s Hospital, Department of Pediatrics, Section of Neonatology, Houston, TX 77030, USA
³ Houston Center for Quality of Care and Utilization Studies, Department of Veterans Affairs, Health Services Research and Development Center of Excellence, Houston Veterans Affairs Medical Center, Houston, TX 77030, USA
⁴ Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA 02115, USA
⁵ Perinatal Research Unit, Kaiser Permanente Medical Care Program, Oakland, CA 94612, USA
⁶ Dugald Baird Centre for Research on Women’s Health, Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen AB25 2ZL, Scotland, UK
⁷ Westmead and Children’s Hospital at Westmead, University of Sydney at Westmead Hospital, Wentworthville, NSW, Australia
⁸ Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK

Correspondence to:
Correspondence to:
Dr Profit
Houston Center for Quality of Care & Utilization Studies, Division of Health Policy and Quality, VA HSR&D (152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; profit{at}bcm.edu

Objective: To compare gestational age at discharge between infants born at 30–34⁺⁶ weeks gestational age who were admitted to neonatal intensive care units (NICUs) in California, Massachusetts, and the United Kingdom.

Design: Prospective observational cohort study.

Setting: Fifty four United Kingdom, five California, and five Massachusetts NICUs.

Subjects: A total of 4359 infants who survived to discharge home after admission to an NICU.

Main outcome measures: Gestational age at discharge home.

Results: The mean (SD) postmenstrual age at discharge of the infants in California, Massachusetts, and the United Kingdom were 35.9 (1.3), 36.3 (1.3), and 36.3 (1.9) weeks respectively (p = 0.001). Compared with the United Kingdom, adjusted discharge of infants occurred 3.9 (95% confidence interval (CI) 1.4 to 6.5) days earlier in California, and 0.9 (95% CI –1.2 to 3.0) days earlier in Massachusetts.

Conclusions: Infants of 30–34⁺⁶ weeks gestation at birth admitted and cared for in hospitals in California have a shorter length of stay than those in the United Kingdom. Certain characteristics of the integrated healthcare approach pursued by the health maintenance organisation of the NICUs in California may foster earlier discharge. The California system may provide opportunities for identifying practices for reducing the length of stay of moderately premature infants.

Abbreviations: IMD, index of multiple deprivation; KPMCP, Kaiser Permanente medical care program; MPIP, moderately premature infant project; NICU, neonatal intensive care unit; PMAD, postmenstrual age at discharge; UKNSS, United Kingdom neonatal staffing study

Keywords: healthcare economics and organisation; premature; hospital stay; discharge; risk adjustment

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Bajaj, N, Nicholl, R (2008). ARE THERE STRATEGIES TO REDUCE THE LENGTH OF STAY FOR WELL NEAR-TERM BABIES?. Arch. Dis. Child. 93: 445-447 [Full Text]  
• Rose, C., Ramsay, L., Leaf, A. (2008). Strategies for getting preterm infants home earlier. Arch. Dis. Child. 93: 271-273 [Full Text]  
• Profit, J., Zupancic, J. A. F., Gould, J. B., Petersen, L. A. (2007). Implementing Pay-for-Performance in the Neonatal Intensive Care Unit. Pediatrics 119: 975-982 [Abstract] [Full Text]  
• Profit, J., McCormick, M. C., Escobar, G. J., Richardson, D. K., Zheng, Z., Coleman-Phox, K., Roberts, R., Zupancic, J. A.F. (2007). Neonatal Intensive Care Unit Census Influences Discharge of Moderately Preterm Infants. Pediatrics 119: 314-319 [Abstract] [Full Text]